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J Am Coll Cardiol, 2006; 47:864-870, doi:10.1016/j.jacc.2005.09.072 (Published online 4 January 2006).
© 2006 by the American College of Cardiology Foundation
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EXPEDITED REVIEW

Comparison of Coronary Artery Bypass Surgery With Percutaneous Coronary Intervention With Drug-Eluting Stents for Unprotected Left Main Coronary Artery Disease

Michael S. Lee, MD, Nikhil Kapoor, MD, Faizi Jamal, MD, Lawrence Czer, MD, Joseph Aragon, MD, James Forrester, MD, Saibal Kar, MD, Suhail Dohad, MD, Robert Kass, MD, Neal Eigler, MD, Alfredo Trento, MD, Prediman K. Shah, MD and Raj R. Makkar, MD*

Cedars-Sinai Medical Center, University of California, Los Angeles School of Medicine, Los Angeles, California.

Manuscript received June 16, 2005; revised manuscript received August 10, 2005, accepted September 8, 2005.

* Reprint requests and correspondence: Dr. Raj R. Makkar, Cardiovascular Intervention Center, Cedars-Sinai Medical Center, 8631 West Third Street, Room 415E, Los Angeles, California 90048. (Email: Raj.Makkar{at}cshs.org).

OBJECTIVES: This study evaluated the clinical outcomes of consecutive, selected patients treated with coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main coronary artery (ULMCA) disease.

BACKGROUND: Although recent data suggest that PCI with DES provides better clinical outcomes compared to bare-metal stenting for ULMCA disease, there is a paucity of data comparing PCI with DES to CABG.

METHODS: Since April 2003, when DES first became available at our institution, 123 patients underwent CABG, and 50 patients underwent PCI with DES for ULMCA disease.

RESULTS: High-risk patients (Parsonnet score >15) comprised 46% of the CABG group and 64% of the PCI group (p = 0.04). The 30-day major adverse cardiac and cerebrovascular event (MACCE) rate for CABG and PCI was 17% and 2% (p < 0.01), respectively. The mean follow-up was 6.7 ± 6.2 months in the CABG group and 5.6 ± 3.9 months in the PCI group (p = 0.26). The estimated MACCE-free survival at six months and one year was 83% and 75% in the CABG group versus 89% and 83% in the PCI group (p = 0.20). By multivariable Cox regression, Parsonnet score, diabetes, and CABG were independent predictors of MACCE.

CONCLUSIONS: Despite a higher percentage of high-risk patients, PCI with DES for ULMCA disease was not associated with an increase in immediate or medium-term complications compared with CABG. Our data suggest that a randomized comparison between the two revascularization strategies for ULMCA may be warranted.

Abbreviations and Acronyms
  ARTS = Arterial Revascularization Therapies Study
  CABG = coronary artery bypass graft
  DES = drug-eluting stent
  MACCE = major adverse cardiac and cerebrovascular event
  PCI = percutaneous coronary intervention
  ULMCA = unprotected left main coronary artery




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